Healthcare Provider Details

I. General information

NPI: 1932101573
Provider Name (Legal Business Name): TINA S BRICKERT CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 E DISCOVERY PKWY
BLOOMINGTON IN
47408-9059
US

IV. Provider business mailing address

PO BOX 1557
MARTINSVILLE IN
46151-0557
US

V. Phone/Fax

Practice location:
  • Phone: 812-918-3400
  • Fax: 812-918-5831
Mailing address:
  • Phone: 765-349-4600
  • Fax: 765-349-6590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number72000016A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: